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Mitral Stenosis III: Medical Management

Mitral Stenosis III: Medical Management

Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...

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Updated: Jan 10, 2026

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Published on: March 26, 2018

Simplified Approach for Minimally Invasive Mitral Valve Surgery Through a Transaxillary Minithoracotomy Access.

Pietro Giorgio Malvindi¹, Olimpia Bifulco¹, Francesca Spagnolo¹

¹Cardiac Surgery Unit, University Hospital of Marche, Polytechnic University of Marche, Ancona, Italy.

The Annals of Thoracic Surgery

|November 19, 2025

Summary

Minimally invasive mitral valve surgery using a simplified transaxillary approach demonstrates excellent outcomes and low complication rates. This technique can help overcome skepticism and promote wider adoption of minimally invasive cardiac surgery programs.

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Area of Science:

Cardiovascular Surgery
Minimally Invasive Cardiac Surgery
Thoracic Surgery

Background:

Skepticism exists regarding the complexity and duration of minimally invasive cardiac procedures.
A simplified surgical setup using right transaxillary minithoracotomy direct view access is presented to address these concerns.

Purpose of the Study:

To evaluate the feasibility and outcomes of a simplified minimally invasive mitral valve surgery approach.
To demonstrate the technical success and safety of the transaxillary approach for mitral valve surgery.

Main Methods:

Retrospective study of consecutive patients undergoing transaxillary mitral valve surgery from January 2017 to December 2024.
Inclusion of 615 patients, with a focus on mitral valve repair for degenerative disease (94%).

Main Results:

Low 30-day mortality (0.3%) and stroke/TIA rates (0.9%).
Short postoperative recovery: median intubation 2 hours, 51% extubated in OR, median ICU stay 24 hours, median hospital stay 7 days.
Excellent long-term results: 98% none/mild residual mitral regurgitation post-repair, 99% survival at 1 year, 96% at 6 years.

Conclusions:

Transaxillary minimally invasive mitral surgery offers excellent technical results and low perioperative complication rates.
A simplified surgical setup enhances the perceived value and facilitates wider adoption of minimally invasive cardiac surgery programs.